Gaca Jeffrey G, Zwischenberger Brittany A, Carr Keith, Wang Andrew, Glower Donald D
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham NC, USA.
Innovations (Phila). 2025 Jan-Feb;20(1):80-86. doi: 10.1177/15569845251315728. Epub 2025 Feb 14.
Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery.
There were 3,044 consecutive adult patients undergoing mitral valve surgery via right thoracotomy from 1996 to 2022 examined from a prospectively maintained database. Propensity score matching was used to compare outcomes of axillary versus aortic cannulation in 241 matched pairs and axillary versus femoral cannulation in 356 matched pairs.
Arterial cannulation was axillary (770 of 3,044; 25%) versus femoral (149 of 3,044; 5%) or central aortic (2,125 of 3,044; 70%). Axillary versus aortic or femoral patients were older ( < 0.001), more often redo ( < 0.001), more urgent ( < 0.001), and had more mitral replacement ( < 0.001) and tricuspid procedures ( < 0.001). After propensity score matching, cannulation groups did not differ in patient characteristics or concurrent surgical procedures. For matched patients, axillary artery cannulation was not independently associated with operative mortality ( = 0.3), postoperative respiratory failure ( = 0.3), perioperative stroke ( = 0.7), renal insufficiency ( = 0.4), pump time ( = 0.6), clamp time ( = 0.2), transfusion ( = 0.5), perioperative length of stay ( = 0.7), or survival ( = 0.6). Axillary cannulation increased operative time by 14 ± 7 min ( = 0.04) versus aortic or femoral artery cannulation.
Right axillary artery cannulation is a safe alternative for right minithoracotomy mitral surgery. Advantages may include avoidance of the aorta in reoperations or older patients, avoidance of peripheral atherosclerosis in older patients, and a low incidence of limb ischemia or wound infection. Disadvantages may include longer access time and an additional chest incision.
腋动脉插管技术不断改进，并在心脏手术中得到广泛应用。然而，与右胸小切口二尖瓣手术中股动脉或中心动脉插管相比，早期结果的记录较少。
从一个前瞻性维护的数据库中检查了1996年至2022年期间连续3044例接受右胸切口二尖瓣手术的成年患者。采用倾向评分匹配法比较241对匹配患者中腋动脉插管与主动脉插管的结果，以及356对匹配患者中腋动脉插管与股动脉插管的结果。
动脉插管方式为腋动脉插管（3044例中的770例；25%）、股动脉插管（3044例中的149例；5%）或主动脉中心插管（3044例中的2125例；70%）。与主动脉或股动脉插管患者相比，腋动脉插管患者年龄更大（<0.001），再次手术的比例更高（<0.001），病情更紧急（<0.001），二尖瓣置换术（<0.001）和三尖瓣手术（<0.001）的比例更高。倾向评分匹配后，插管组在患者特征或同期手术方面没有差异。对于匹配患者，腋动脉插管与手术死亡率（=0.3）、术后呼吸衰竭（=0.3）、围手术期卒中（=0.7）、肾功能不全（=0.4）、体外循环时间（=0.6）、阻断时间（=0.2）、输血（=0.5）、围手术期住院时间（=0.7）或生存率（=0.6）均无独立相关性。与主动脉或股动脉插管相比，腋动脉插管使手术时间增加了14±7分钟（=0.04）。
右腋动脉插管是右胸小切口二尖瓣手术的一种安全替代方法。优点可能包括再次手术或老年患者避免主动脉操作、老年患者避免外周动脉粥样硬化以及肢体缺血或伤口感染发生率低。缺点可能包括更长的置管时间和额外的胸部切口。
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